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General NPI Number Information
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NPI Number | 1346509775
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Entity Type | Organization
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Legal Business Name | ESSENTIAL SELF, LLC
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 1501 15TH ST NW SUITE 107
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City | AUBURN
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State | WA
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Zip | 98001-3507
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Country | US
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Telephone | 253-929-8732
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Fax | 253-929-8738
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Provider Business Mailing Address
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Address Line | 1501 15TH ST NW SUITE 107
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City | AUBURN
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State | WA
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Zip | 98001-3507
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Country | US
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Telephone | 253-929-8732
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Fax | 253-929-8738
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. CAROLE A. HAYES
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Credential | CDP, LMHC
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Telephone | 253-929-8732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LH60172456
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License Number State | WA
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